Male Infertility and the Psychological Impact

By: Dr. Wiyatta Fahnbulleh, Clinical Psychologist

The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.

While many believe that fertility challenges are primarily a women’s issue, the truth is that men can also face fertility problems. Infertility is a condition that affects many couples who dream of starting a family, and about half of infertility cases are due to male factor infertility.

The World Health Organization (WHO) defines infertility as “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse,” and the American Society for Reproductive Medicine (ASRM) defines infertility as “the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.”

Male factor infertility is a prevalent issue affecting couples worldwide. Nevertheless, male factor infertility is rarely discussed and is sometimes seen as more taboo than infertility for females and non-binary birthing persons.

Common causes of male factor infertility

Male factor infertility occurs when a person assigned male at birth (AMAB) has difficulty achieving pregnancy with their partner or donor assigned female at birth (AFAB) due to issues related to their reproductive system. These reproductive health problems can include low sperm count, poor sperm motility (movement), abnormal sperm morphology (shape), or blockages in the reproductive tract. Male infertility can stem from multiple causes, such as hormonal imbalances, genetic factors, physical abnormalities, lifestyle choices, or other medical conditions and health issues that aren’t related to reproductive health. It’s important for people AMAB to do a semen analysis at the beginning of their fertility or trying-to-conceive journey to get an early assessment.

Oligospermia (low sperm count)

One of the leading causes of male infertility is having a low sperm count. Sperm count refers to the number of sperm cells present in a man’s semen. When the sperm count is lower than expected, it becomes more difficult for the sperm to reach and fertilize an egg.

Azoospermia

This occurs when there is no sperm in the semen due to a blockage or low sperm production.

Morphology (abnormal sperm shape) and motility (poor sperm movement)

Sometimes, even if a man has an average sperm count, they may not be healthy sperm, having abnormal shapes or movements, making it harder to swim toward the egg and fertilize it.

Medical conditions

Medical conditions affecting male fertility include cancer (and cancer treatment), prior surgeries, ejaculation issues, erectile dysfunction, and structural conditions like varicocele (enlarged veins on the testicles).

Hormonal imbalances

Hormones play a crucial role in sperm production. Imbalances in hormone levels can affect the production and semen quality.

Genetic factors

Certain genetic conditions can also contribute to male infertility. For example, Klinefelter syndrome, in which a man has an extra X chromosome, can lead to lower sperm production and azoospermia.

Lifestyle factors

Certain lifestyle choices can also impact male fertility. Factors like smoking, excessive alcohol consumption, drug use, obesity, and exposure to certain chemicals or toxins can reduce sperm quality and quantity.

Regardless of the cause of male infertility, one thing is sure: an infertility diagnosis can have profound psychological consequences.

The psychological impact of male factor infertility

When we think about infertility, we often forget that men experience a sense of loss and may grieve the loss of the life they imagined. Because much of the focus is on the female partner, we forget to focus on the emotional needs of the male and how the news of fertility challenges may impact them. In relationships, people sometimes feel that the male partner is not as impacted as the female partner and that he may not experience grief, leaving them with nowhere to turn and no one with whom to share their pain.

The psychological impact for men struggling with infertility can extend beyond the initial diagnosis and touch various aspects of a man’s life, impacting their mental health and overall well-being.

The diagnosis of male infertility can evoke a range of emotions, including sadness, anger, guilt, shame, a sense of failure, frustration, anxiety, depression, and inadequacy. Men often experience a loss of masculinity and self-esteem, grieving the ability to conceive naturally and questioning their role as potential fathers, as society often links virility to one’s ability to conceive. The emotional burden can be further intensified due to other societal expectations, cultural beliefs, and personal desires to father a child. Plus, there’s often pressure to hide these feelings due to social norms that dictate men should be stoic and emotionally strong. Often when working with male clients, I find it is common for them to minimize the emotional toll an infertility diagnosis has on them.

The emotional toll can be further intensified when couples face the pressure of time constraints and the financial burden of fertility treatments or assisted reproductive technologies.

Other psychological aspects that may be affected by male infertility:

Relationship dynamics

The inability to conceive naturally can put immense strain on relationships with partners, family, and friends. The stress and emotional toll can create communication challenges and lead to conflicts, which, if left unaddressed, can erode the intimacy and closeness shared between partners. It is crucial for couples to support each other during this difficult time and seek professional help if needed.

Social interactions

Male factor infertility can impact social interactions as well. Men may feel isolated and hesitant to share their struggles with friends and family, fearing judgment or misunderstanding. Attending gatherings or events where children are present can evoke a sense of sadness and longing, which may lead to social withdrawal.

Men must recognize that infertility is not a reflection of their worth or masculinity and seek support to help overcome these negative self-perceptions.

Improving well-being and seeking support

The psychological impact of male factor infertility underscores the importance of addressing mental health and seeking support. Here are some strategies that can contribute to overall well-being:

Open communication

Couples should establish open, honest communication channels to express their emotions, concerns, and expectations. Sharing the journey can alleviate the emotional burden and strengthen the bond between partners.

Seeking professional help

Reproductive psychologists and counselors can provide valuable guidance and support throughout the infertility journey. They can assist in managing emotions, improving coping strategies, and enhancing communication within the relationship. There are also virtual fertility coaches who can help support men on their fertility journeys, through text messaging, if that’s an easier way to open up.

Male infertility support groups

Joining support groups or seeking out online communities can provide a safe space for men to share experiences, gain insights, and receive emotional support from others who understand the challenges of male factor infertility.

Self-care

Engaging in self-care activities, such as exercise, hobbies, and relaxation techniques, can help reduce stress and promote mental well-being. Prioritizing self-care supports overall resilience during the infertility journey.

Male infertility treatment options

If you and a partner have been trying to get pregnant for several months with no success, consider meeting with a fertility specialist (or reproductive endocrinologist) who may refer you to a reproductive urologist to begin appropriate testing (including a semen analysis) to screen for issues regarding your fertility. Although it is a journey you may not want to embark on, it is better to begin treatment early than to continue to put off treatment due to fear and shame.

There are many treatment options available for male factor infertility, some of which include:

Medications

Doctors may sometimes prescribe medications to help treat male infertility. These medications can help balance hormone levels, improve sperm production, and enhance sperm motility (movement).

Surgery

If there is a blockage in the male reproductive system, surgery may be necessary to correct the issue. Surgery can also help to repair varicoceles, which are enlarged veins in the scrotum that can affect sperm function and production.

Assisted reproductive technology

In cases where natural conception is not possible, healthcare providers can utilize assisted reproductive techniques. The most common technique is in vitro fertilization (IVF), where eggs are collected from the female partner and combined with sperm in a laboratory. The fertilized eggs grow into embryos and are transferred to the uterus.

Intracytoplasmic sperm injection (ICSI)

ICSI is an infertility treatment using a tiny needle to inject live sperm into a person’s eggs in a laboratory.

Lifestyle changes

Making positive changes to one’s lifestyle can significantly improve male fertility. Quitting smoking, reducing alcohol consumption, maintaining a healthy weight through regular exercise, and avoiding exposure to harmful substances can all positively impact sperm quality and quantity.

Male factor infertility is a prevalent issue affecting men’s health emotionally, psychologically, and socially. Understanding the psychological impact of male factor infertility is crucial for individuals and couples facing fertility challenges. By recognizing the potential psychological distress and seeking appropriate support, men can navigate the journey with improved mental and emotional well-being. Remember, infertility does not define an individual’s worth or masculinity, and resources are available to support those facing these challenges. Always remember that infertility is a medical condition that impacts many individuals. You are not alone.

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